What has changed in the Senate health care bill, and what hasn't?

By Kathryn Watson

July 14, 2017 / 5:26 PM
/ CBS News

Health care update

The latest Senate GOP health care bill, known as the Better Care Reconciliation Act (BRCA), revised and released Thursday after the first proposal failed to gain enough votes to pass, has a few key differences from the earlier version, and some crucial similarities.

The changes were made in an attempt to appease both moderate and conservative Republican members, as Senate Majority Leader Mitch McConnell looks to vote on the bill as early as next week. The Congressional Budget Office has yet to score the latest proposal, although the CBO found the earlier bill, released in June, would leave 22 million more people uninsured.

Things Senate Republicans changed from the original bill:

Permission for bare-bones health insurance plans

Under Obamacare, health insurance plans had to provide a number of "essential" benefits, for things like maternity care and emergency room visits. The latest Senate bill includes an amendment from Sen. Ted Cruz (R-Texas) that allows insurers to offer cheaper, bare-bones plans that cover fewer services, so long as those insurers also provide plans that cover the benefits defined in Obamacare.

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Taxes on affluent people

The latest Senate proposal, unlike the earlier one, keeps some key Obamacare taxes on wealthier families, like the 3.8 percent tax on investment income on individuals earning more than $200,000, and families earning more than $250,000. The bill also keeps a 0.9 percent Medicare tax on those high-income earners.

Funding to fight opioid addiction

The latest Senate bill provides $45 billion to fight the opioid epidemic that has swept the nation, after some senators -- especially those whose states have been hardest hit by the crisis -- expressed a need for more federal attention to the matter. Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-West Virginia) originally asked for $45 billion to fight addiction, but the original Senate bill only allocated $2 billion. More people now die in the U.S. annually from drug overdoses than from car accidents or gunshot wounds.

Allows health savings accounts to pay for premiums

Health savings accounts, a tax-free form of health care funding often pushed by conservatives, tend to be used more by higher-income Americans than lower-income ones. The latest GOP bill permits HSAs to fund health insurance premiums, something current law does not allow.

Things the Senate did not change from the original bill:

Medicaid

The treatment of Medicaid remains largely the same in the latest Senate bill, slowing spending on the program for low-income, disabled and elderly individuals and families. Like the earlier Senate bill, the latest proposal phases out federal funding for able-bodied, childless adults provided under Obamacare in states that expanded Medicaid. It also retains the earlier bill's restructuring of Medicaid financing. Currently, the federal government pays a fixed percentage of state Medicaid costs -- about 64 percent, according to the Center on Budget and Policy Priorities (CBPP). The BCRA would switch to a capped per-capita structure starting in 2020, although states would also have the option of a block grant for adult recipients. According to CBPP, the funding formula used by the Senate is even less generous than the House version's "inadequate level." That results in considerably steeper cuts in the Senate bill -- 35 percent by 2036, compared to current law, according to the Congressional Budget Office's (CBO) estimate.

A couple of moderate Republican senators, according to some reports, had asked that the Medicaid cuts be considered separately, arguing that outside of the Medicaid expansion, the funding structure was not changed by the ACA.

Planned Parenthood funding

Like the first Senate proposal, the latest Senate bill cuts federal funding for Planned Parenthood for one year, and prohibits people from using Medicaid's services at any Planned Parenthood facility. That provision is unsettling to some Senate moderates, like Sen. Susan Collins (R-Maine), who opposed cutting Planned Parenthood funding. Collins has already said it's "very likely" she'll vote no on putting the bill on the floor.

Coverage requirements

Like the earlier Senate bill, and the House bill, the latest Senate proposal does not require people to have health insurance and has no financial penalties for people who choose not to have health insurance. The bill, like the earlier Senate proposal, also repeals Obamacare's requirement that businesses with 50 or more employees provide health insurance.